Digestive & Liver Diseases (Gastroenterology)
Types of Surgery
The Montefiore Medical Center Comprehensive Liver Program provides several options in hepatobiliary surgery, performed by our highly specialized surgical team.
Removal of a portion of the liver is performed most commonly for cancer, but it is also required for some benign conditions. During hepatic resection, the liver tissue (parenchyma) is divided, which causes bleeding and leakage of bile. It is important that the remaining liver has sufficient size and function to avoid complications. Hepatic resection is a complex procedure that is best performed by skilled surgeons with experience in hepatobiliary surgery. Most hepatic resections take from two to four hours, and patients recover in the hospital for approximately five to seven days, or fewer if possible, depending on the size of the resection. After discharge, patients are sent home with a careful follow-up plan at the Liver Center. Most patients recovering at home have limited activity for the first four to six weeks but are able to walk and eat normally.
Laparoscopic (Minimally Invasive) Hepatic Resection
This type of liver surgery is performed through small incisions using a camera and special instruments. During a laparoscopic hepatic resection, portions of the liver can be removed without a large incision. Recovery is significantly shorter and less painful. This surgical solution is not viable in every case, but patients should discuss this option with a surgeon. All the hepatobiliary surgeons at the Montefiore Comprehensive Liver Program are experts in laparoscopic liver surgery, including Dr. Sarah Bellemare who has pioneered this field.
Tumors in the liver are destroyed by using microwave heat, placing a needle (probe) in the tumor and then heating the tip to high temperatures. The needle is placed in the tumor using guidance by ultrasound or CT scan. Ablation is a useful option in destroying liver tumors that are smaller (less than five centimeters) and difficult to remove by resection. In some cases, patients whose livers are too diseased to undergo resection may be better served by ablation, which is performed alone or in conjunction with other therapies. Ablation, which is performed more than once, is achieved laparoscopically or through the skin (percutaneously) by a radiologist. In most cases, percutaneous ablations require one day in the hospital.
Surgery for the Gallbladder and Biliary Tract
Numerous conditions lead to surgery on the gallbladder and bile ducts. The gallbladder is not part of the liver; it is closely adjacent to it. The gallbladder is not required for normal function, and patients whose gallbladders have been removed do not suffer any long-term side effects. At most hospitals, general surgeons perform routine gallbladder surgery. However, only specialized surgeons should perform complex surgery on the bile ducts, because complications can be severe and life threatening. The advanced hepatobiliary surgical team at the Liver Center is made up of specialists in the reconstruction of bile ducts injured by trauma or diseases, including cancers.
Liver transplantation is a highly complex operation during which the failed liver is removed and then replaced with new liver grafts from either brain-dead donors or live donors. The surgical team at the Liver Center is highly skilled in liver transplantation. All of our surgeons have years of experience and specialty training specifically in liver transplantation. The team is composed of hepatobiliary surgeons, as well as hepatologists, nurse coordinators and other clinicians who perform evaluation and follow-up care.